Comparative Outcomes of Vaginal and Abdominal Surgical Approaches for Advanced Pelvic Organ Prolapse in a Tertiary Care Hospital in Pakistan: A Prospective Cohort Study

Objective: To compare the surgical outcomes of vaginal sacrospinous ligament fixation and abdominal sacrocolpopexy for the treatment of advanced pelvic organ prolapse (POP) in women. The primary outcomes assessed were the recurrence rate of prolapse, improvement in symptoms, and postoperative complications. Methodology: A retrospective cohort study was conducted at the Department of Cardiology, Hayatabad Medical Complex, Peshawar, Pakistan, from Jan 2024 to Jun 2024. A total of 100 women with advanced POP were included, divided into two groups: 50 underwent vaginal sacrospinous ligament fixation, and 50 underwent abdominal sacrocolpopexy. Data were collected on patient demographics, comorbidities, surgical details, and postoperative outcomes. Statistical analysis included chi-square tests for categorical variables and independent t-tests for continuous variables. Results: The results revealed that 18% of patients in the vaginal surgery group experienced prolapse recurrence, compared to only 8% in the abdominal surgery group (p = 0.042). Furthermore, 76% of patients in the vaginal surgery group reported symptom improvement, while 92% of those in the abdominal group showed significant improvement (p = 0.039). The mean age of the vaginal surgery group was 58.4 years, and the abdominal group was 60.5 years. The mean BMI for the vaginal group was 26.8, and for the abdominal group, it was 27.2. Conclusion: Abdominal sacrocolpopexy resulted in superior outcomes in terms of both prolapse recurrence and symptom improvement compared to vaginal sacrospinous ligament fixation. These findings support abdominal sacrocolpopexy as the preferred surgical approach for advanced POP.